This Issue at a Glance

Abstract

Ip et al (p. 367) assessed the effects of intravitreal injections of the anti-vascular endothelial growth factor (VEGF) ranibizumab on the severity of diabetic retinopathy (DR) for up to 3 years. They also evaluated the effect of delayed treatment on DR severity and identified baseline patient characteristics associated with proliferative DR (PDR). They found that anti-VEGF treatment both improves DR severity and prevents worsening—and that prolonged delays in initiation of intravitreal injections may limit this therapeutic effect. Moreover, they found that development of PDR, although uncommon, may be related to the presence of macular nonperfusion. For this study, 759 patients with diabetic macular edema were randomized to receive either sham injections or injections of 0.3 mg or 0.5 mg of the drug; sham participants could then crossover to 0.5-mg injections during the third year. At 3 years, a greater proportion of treated eyes had ≥2- or ≥3-step DR improvement compared with those in the sham/crossover group. Using the National Eye Institute’s visual function questionnaire (NEI VFQ)-25 and standard automated perimetry (SAP), Medeiros et al (p. 293) evaluated the link between quality of life and progressive visual field (VF) loss in glaucoma. They found a statistically significant correlation, with both baseline VF severity and the magnitude of change in binocular sensitivity associated with a decline in patients’ quality of life. In addition, they found that rapid declines in VF loss produced sharp declines in the NEI VFQ-25 scores. For this prospective study, 161 patients (322 eyes) with glaucomatous VF loss were followed for an average of 3.5±0.7 years. The NEI VFQ-25 was administered yearly, and SAP was performed every 6 months. The researchers noted that assessment of longitudinal VF changes may help identify those patients who are at higher risk for developing disability from their glaucoma. Koolwijk et al (p. 281) assessed the safety of their ophthalmologist-led, non–anesthesia-supported cataract surgery service. They found that it was safe, and that basic first aid and basic life support skills appear to be sufficient in case of an adverse event. For this retrospective observational study, the researchers evaluated 4347 patients (6961 cases) who underwent elective phacoemulsification under topical anesthesia in the outpatient cataract surgery unit. The primary outcome measure was the incidence of adverse events requiring attention from the parent hospital’s medical emergency team (MET). Three patients needed MET attention; all 3 were diagnosed as having vasovagal collapse and recuperated uneventfully without requiring hospital admission. A total of 38 patients were transferred to the parent hospital’s operating room, and all but one of this group received general anesthesia. Reasons for these transfers included intellectual disability and/or psychological factors. Budenz et al (p. 308) compared the 5-year outcomes of the Ahmed Glaucoma Valve (AGV) and the Baerveldt Glaucoma Implant (BGI) for the treatment of refractory glaucoma. They found that success rates were similar with the 2 devices and that the BGI produced greater reduction in intraocular pressure (IOP) and a lower rate of reoperation. However, they also found that patients who received the BGI also experienced twice as many failures due to safety issues such as persistent hypotony, loss of light perception, or explantation. This randomized controlled trial involved 276 patients. At 5 years, IOP was 14.7±4.4 mmHg in the AGV group (n = 143) and 12.7±4.5 mmHg in the BGI group (n = 133), and the number of glaucoma medications in use at the 5-year mark was 2.2±1.4 in the AGV and 1.8±1.5 in the BGI cohorts, respectively. While 46 patients in the AGV group and 25 in the BGI group required re-operation or had inadequately controlled IOP, 11 patients in the AGV cohort experienced device failure, compared with 22 of those who received the BGI. In a continuation of an earlier trial, Elman et al (p. 375) set out to assess whether the benefit of initial focal/grid laser plus intravitreal ranibizumab injections for diabetic macular edema (DME) could be sustained over a longer period of time. They found that it could, as most eyes initiating ranibizumab with prompt or deferred (for ≥24 weeks) laser maintained vision gains through the 5-year mark. For this extension study, 124 and 111 participants completed the 5-year visit in the prompt and delayed laser groups, respectively. Mean change in visual acuity through 5 years was +7.2 letters in the prompt laser group vs +9.8 letters in the delayed laser group; from baseline through 5 years, 56% of those in the delayed laser group did not receive any laser treatments. The median number of intravitreal injections was 13 vs. 17 in the prompt and delayed groups, including 54% and 45% receiving no injections during year 4 and 62% and 52% receiving no injections during year 5, respectively.